Healthcare Provider Details

I. General information

NPI: 1982159059
Provider Name (Legal Business Name): LANSING GARDENS REHABILITATION AND CARE CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/18/2016
Last Update Date: 08/18/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

99 W HAWTHORNE AVE
VALLEY STREAM NY
11580-6163
US

IV. Provider business mailing address

68222 COMMERCIAL DR
BRIDGEPORT OH
43912-1520
US

V. Phone/Fax

Practice location:
  • Phone: 516-505-0000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number1750N
License Number StateOH

VIII. Authorized Official

Name: DAVID GAMZEH
Title or Position: MANAGING MEMBER
Credential:
Phone: 516-426-6961